最初因末期脏病接受透析治疗的儿童的死亡风险,1990-2010年
Mark M Mitsnefes1, Benjamin L Laskin, Mourad Dahhou
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
JAMA
|May 7, 2013
概括
治疗透析的末期病 (ESKD) 的儿童和青少年的死亡率在1990年至2010年期间显著下降. 这项研究突出了20多年来儿科ESKD护理的改进.
科学领域:
- 儿科脏病学 儿科脏病学
- 脏替代疗法治疗 脏替代疗法
- 慢性病的流行病学 慢性病的流行病学
背景情况:
- 大多数患有末期病 (ESKD) 的儿童在移植之前接受透析.
- 在接受透析的儿科ESKD患者的死亡率最近的趋势尚未得到充分证实.
研究的目的:
- 评估1990年至2010年期间为ESKD启动透析的儿童和青少年所有原因,心血管和感染相关死亡率的变化.
- 评估治疗开始年对儿科透析患者死亡风险的影响.
主要方法:
- 从1990年到2010年使用美国脏数据系统 (USRDS) 进行的回顾性队列研究.
- 包括21岁以下为ESKD启动透析的患者,不包括之前移植过的患者.
- 考克斯的比例危险模型被用来分析与透析开始年份的5年增量相关的死亡风险,对脏移植进行审查.
主要成果:
- 这项研究分析了23,401名为ESKD启动透析的儿童和青少年.
- 在透析期间的死亡率从1990-1994年到2005-2010年在5岁以下和5岁以上的年龄组显著下降.
- 每增加5年的透析启动年与死亡风险比率的降低有关 (HR 0.80为<5年,HR 0.88为≥5年).
结论:
- 在1990年至2010年期间,美国儿童和青少年因ESKD开始透析时,死亡率大幅下降.
- 这些发现表明,在研究期间,儿科ESKD患者在透析治疗的管理和结果显著改善.
- 需要进一步的研究来确定导致这种死亡率下降的具体因素.
相关概念视频
01:15Dialysis
2.1K
Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
2.1K
01:27Dialysis
2.2K
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
2.2K
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
337
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
337
01:28Kidney Transplant I: Introduction
827
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
827
01:25Chronic Kidney Disease I: Introduction
1.4K
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
1.4K
01:28Chronic Kidney Disease III: Interprofessional Care
679
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
679